2015 Legislative Day in Columbus

Cardiology Day at the Capitol: Advocating for a Healthy Ohio

March 3, 2015

Sen. Jordan

The Ohio-ACC held its annual legislative day in Columbus, Ohio. Members visited their Ohio representatives and senators to introduce them to cardiology issues facing them and their patients. Building relationships with state lawmakers helps to ensure that the Ohio General Assembly remains informed about issues facing providers and patients. In addition, John McCarthy, Director, Ohio Department of Medicaid, spoke to attendees about Transforming Payment for a Healthier Ohio, which addresses paying for health care value instead of volume across Medicaid, state employee, and commercial populations.

Talking Points

ISSUE #1: State Budget-HB 64

Sponsor: Rep. Ryan Smith (R –Bidwell )
Status: Introduced, currently being debated in the House Finance Committee

The 72 billion dollar budget proposal for 2016-2017 contains a number of provisions that impact physicians and health care.

Tobacco tax- SUPPORT: The budget includes an increase to the cigarette tax to deter smoking by $1.00 per pack – this would make the new tax rate $2.25 per pack. Also it increases the tax rate on other tobacco products, including e-cigarettes, to equalize their tax rates with the cigarette tax rate.

GME cut- OPPOSE: The budget decreases direct GME payments beginning in 2016 by $25M. These funds would be dedicated to increasing primary care reimbursement.

Medicaid-OPPOSE: The budget proposes a change to use Medicaid maximum payment rates, instead of Medicare maximum payment rates, for all crossover claims when patients are dual-eligible for Medicare and Medicaid benefits. This is a cut of about 20%. These funds would be dedicated to increasing primary care reimbursement.

ISSUE #2: Prior Authorization Simplification Act – Support

Sponsor: Sen. Randy Gardner (R – Bowling Green)
Status: Will be introduced next week
Policies that require physicians to ask permission from a patient’s insurance company before performing a treatment are known as “prior authorization” (PA). Prior Authorizations have disrupted the physician-patient relationship. PA requirements often lead to a delay in diagnosis and treatment of the patient’s condition. It causes a significant administrative burden on the physician’s practice and results in no improvement in the quality of care.
This legislation will address those issues by requiring the following:
• Ensure that PA requirements or restrictions are listed on the health insurer’s Web site;
• Allow providers and patients to obtain PA’s through a web-based system;
• Ensure that a new or future PA requirement is disclosed at least 60 days prior to the new requirement being implemented;
• Guarantee that once a PA has been approved, the insurer will not retroactively deny coverage for the approved service;
• Disclose on their web sites statistics regarding PA approvals and denials;
• Guarantee a 48-hour turnaround on PA requests and 24-hour turnaround for more urgent requests;
• Use prior authorization protocols that use evidence-based clinical review criteria;
• Ensure a streamlined appeals process in the event a prior authorization denied.

Fifteen other states have enacted legislation addressing the issue of Prior Authorization. The legislation varies by state but all include measures that strengthen the communication between patients, providers, pharmacies and insurers making the PA process easier for patients to be granted the care they need.

The Ohio State Medical Association (OSMA) is leading the charge on this legislation along with the support of the following organizations:
Ohio Chapter of the American College of Cardiology
Ohio Hospital Association
Ohio Dermatological Association
American Academy of Pediatrics, Ohio Chapter
Ohio Hematology Oncology Society
Ohio Ophthalmological Society
Ohio Osteopathic Association
Ohio State Chiropractic Association
Ohio Foot and Ankle Medical Association
American Congress of Obstetricians & Gynecologists, Ohio Section
Ohio Optometric Association
The Academy of Medicine of Cleveland & Northern Ohio
Ohio Psychiatric Physicians Association

ISSUE #3: Medical Liability Reform

Sponsor: Rep. Bob Cupp (R –Lima )
Status: Not yet introduced

In an effort to continue to improve Ohio’s medical liability climate and expand upon the positive impact of tort reform in our state, Speaker Cliff Rosenberger has indicated he wants to make medical liability reform a priority this General Assembly. The legislation is still in the drafting stages but The Ohio-ACC along with the OSMA would like to see the following issues addressed in the legislation:

Abolish the “Loss of Chance Theory” of Liability
In 1996, the Ohio Supreme Court adopted the “loss of chance” theory of liability and significantly altered the medical malpractice landscape. Before the Court created this theory of liability, the plaintiff’s success in proving causation in a medical malpractice case hinged on a simple criterion: Did the plaintiff establish that an injury or death was more likely than not caused by the defendant’s negligence? If yes, the plaintiff was awarded damages and, if no, the plaintiff would not prevail.

The “loss of chance” theory changed this and effectively permits a plaintiff to be awarded compensation (assuming a physician’s negligence) for a reduction in their chance of a favorable medical outcome, even if that chance was originally less than 50%. This theory significantly altered the burden of proof in medical liability cases in favor of the plaintiff. It also exemplified the result of judicial imprecision when Courts create new theories of liability. In this case, the plaintiff is not required to establish a “loss of chance” in an exact percentage, yet the potential award is calculated as a percentage of the total damages.

The Apology Statute (HB 276 from the previous General Assembly)
Current Ohio law provides that, in a civil action regarding an unanticipated outcome of medical care, any expressions of apology or sympathy made by a health care provider are inadmissible as evidence of liability. However, there is a gray area in the law that allows a patient to potentially confuse an apology with an admission of fault. While a health care provider may offers words intended as an apology, the patient may hear an admission of fault in those same words. Admissions of fault are currently admissible in a civil action.

Last General Assembly’s proposed legislation included admissions of fault or error as inadmissible in a civil action, thereby protecting the health care provider’s ability to extend apologies, expressions of sympathy or admissions without fear of a medical malpractice lawsuit. It should be noted that the legislation did nothing to remove the ability of a capable plaintiff’s attorney to utilize current discovery tools to explore whether a medical outcome warrants a lawsuit. Additionally, eight other states have enacted a similar reform.
We would like these measures to be included in the medical liability reform package this General Assembly.

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